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The Role of Insurance Networks and Organizational Factors in Guideline-Concordant Care for Serious Mental Illness

保险网络和组织因素在严重精神疾病指南一致护理中的作用

基本信息

批准号：
10306958
负责人：
Kimberley Lynn H Geissler
金额：
$ 23.93万
依托单位：
UNIVERSITY OF MASSACHUSETTS AMHERST
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-08-13 至 2024-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10306958
关键词：
Address Affect Caring Characteristics Clinical Comprehensive Health Care Comprehensive Health Insurances Cost Sharing Data Data Set Databases Disease Enrollment Family Fee-for-Service Plans Future Goals Guidelines Health Health Insurance Health Services Research Health system Healthcare Healthcare Systems Homelessness Incentives Individual Insurance Link Logistic Regressions Managed Care Massachusetts Medicaid Mental Health Mental Health Services Modeling Outcome Pathway interactions Patient Preferences Patient-Focused Outcomes Patients Pharmaceutical Preparations Physicians Pilot Projects Policies Population Premature Mortality Primary Health Care Privatization Psyche structure Psychiatrist Psychotherapy Regulation Research Risk Role Sampling Schizophrenia Self-Injurious Behavior Shapes Social outcome Subgroup Suicide Suicide attempt System United States Variant behavioral health care outcomes clinical practice comorbidity demographics first episode psychosis health care delivery improved improved outcome insurance plan interest medical specialties mortality secondary analysis severe mental illness substance use suicidal risk young adult

项目摘要

PROJECT SUMMARY Serious mental illness affects more than 5% of the United States population, but only a small proportion of these individuals receive adequate treatment. Schizophrenia impacts one percent of the population and is particularly debilitating. Individuals with schizophrenia have high rates of poor health and social outcomes, including premature mortality, homelessness, and substance use. Individuals with schizophrenia are at increased risk of suicide and have high rates of comorbid disease. Guideline-concordant care (GCC) – including appropriate medications and psychotherapy – improves outcomes for individuals with schizophrenia, including mortality. However, rates of GCC are low, with significant variation across patient demographic groups, clinical conditions, and clinician types. Although some differences may be explained by patient preferences, system factors at the insurance and organization levels likely contribute to low rates of GCC. Better understanding system factors – including the role of insurance networks and organizations – that help guide treatment pathways towards GCC and improve patient outcomes is an important contribution to improving clinical practice for individuals living with schizophrenia. Pursuant to the goals of PAR-19-189, the objective of this pilot services research is to identify mutable health care system factors related to access and quality of mental health services. Using comprehensive health insurance enrollment and claims data from Massachusetts we quantify and examine variation in insurance networks for those with schizophrenia, examine associations of these network characteristics – including size and composition (reflecting availability of mental health clinicians) – with patient outcomes of guideline-concordant care receipt and self-harm. As a potential mechanism for understanding how insurance networks may influence patient outcomes, we examine associations of organizational characteristics – organization size and proportion of mental health clinicians – with patient outcomes. We conduct sensitivity analyses limiting to individuals with first episode psychosis due to the clinical urgency of comprehensive care and policy interest in this population, and establish a causal relationship between insurance networks and organizations and outcomes using a young adult sample. Understanding factors associated with GCC and outcomes will help identify effective policy levers to improve care. Findings from this pilot study will guide future improvements in mental health services delivery, as well as identify avenues for future research on policy changes influencing critical system characteristics.

项目总结